| NPI | 1952355737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 104217-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 104217-1) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-07-08 |